Introduction: Knee osteoarthritis (OA) is a degenerative joint condition with significant global prevalence, often resulting from inflammatory joint processes, trauma, occupational stress, and obesity. While total knee arthroplasty (TKA) effectively alleviates pain and restores function, its limited lifespan and increased revision risk in younger patients necessitate alternative joint-preserving strategies. Emerging evidence highlights the potential of approaches such as Knee Joint Distraction (KJD), High Tibial Osteotomy (HTO), platelet-rich plasma therapy, and radiofrequency ablation in managing knee OA. These noninvasive and joint-preserving interventions have demonstrated efficacy in reducing OA-related pain and improving patient outcomes. Materials and methods: This study evaluated four comparative studies focusing on KJD vs HTO and TKA in the treatment of severe knee OA. Patient-reported outcomes were assessed using validated tools, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Intermittent and Constant Osteoarthritis Pain (ICOAP) score, Visual Analog Scale (VAS) for pain, EuroQol-5 Dimensions (EQ-5D), and Short Form-36 (SF36). Structural outcomes were quantified via Joint Space Width (JSW), an indicator of cartilage preservation. Data were analysed using Review Manager (RevMan) version 5, with Cochrane’s Q test applied to evaluate heterogeneity. Results were summarised using Forest plots, and statistical significance was set at p < 0.05. Results: Statistical analysis revealed significant differences between KJD vs. HTO and TKA across all measured outcomes. HTO and TKA demonstrated superior improvements in WOMAC, KOOS, ICOAP, VAS, EQ-5D, SF-36, and JSW. Despite these statistically significant differences, the mean values were comparable, suggesting KJD’s non-inferiority as a joint-preserving alternative. The efficacy of non-invasive modalities in alleviating knee OA symptoms further strengthens the argument for exploring less invasive, cost-effective options for managing this condition. Conclusion: Knee Joint Distraction emerges as a promising joint-preserving intervention, offering comparable pain relief and functional improvement to HTO and TKA in the management of severe knee OA. While HTO and TKA showed marginally superior outcomes, KJD remains a viable alternative for younger patients or those seeking to delay TKA. Incorporating adjunctive treatments such as plateletrich plasma therapy or radiofrequency ablation may further enhance outcomes, paving the way for multimodal and individualised approaches to knee OA management.

Osteomyelitis is a chronic infection of bones. Eradication of bone infection is usually with antibiotics and debridement, but it is slow and the infection can recur even after many years. It is now established that osteomyelitis is due to biofilm and a better understanding of the process is required. We review the development of biofilm and apply it to osteomyelitis management. The planktonic microbes' response to adverse conditions is the formation of biofilm. Bacterial infections in planktonic forms cause infections that can be controlled with antibiotics and immunisation, however the same microbe when its phenotype becomes biofilm is more resilient. The understanding of how planktonic bacteria convert to biofilm is one of the aims set out for this article.

Adult ; Alternaria ; immunology ; Alveolitis, Extrinsic Allergic ; immunology ; Animals ; Antibodies ; immunology ; Antibodies, Bacterial ; immunology ; Antibodies, Fungal ; immunology ; Antigens ; immunology ; Antigens, Bacterial ; immunology ; Antigens, Fungal ; immunology ; Aspergillus fumigatus ; immunology ; Asymptomatic Diseases ; Candida albicans ; immunology ; Cladosporium ; immunology ; Columbidae ; immunology ; Female ; Healthy Volunteers ; Humans ; Immunoglobulin G ; immunology ; Male ; Melopsittacus ; immunology ; Middle Aged ; Mucor ; immunology ; Nocardia ; immunology ; Parrots ; immunology ; Penicillium chrysogenum ; immunology ; Stachybotrys ; immunology ; Thermoactinomyces ; immunology

INTRODUCTION: Patients referred for chest pain from primary care have increased, along with demand for outpatient cardiology consultations. We evaluated 'Triage Protocol' that implements standardised diagnostic testing prior to patients' first cardiology consultation. MATERIALS AND METHODS: Under the 'Triage Protocol', patients referred for chest pain were pretriaged using a standardised algorithm and subsequently referred for relevant functional diagnostic cardiology tests before their initial cardiology consultation. At the initial cardiology consultation scheduled by the primary care provider, test results were reviewed. A total of 522 triage patients (mean age 55 ± 13, male 53%) were frequency-matched by age, gender and risk cohort to 289 control patients (mean age: 56 ± 11, male: 52%). Pretest risk of coronary artery disease was defined according to a Modified Duke Clinical Score (MDCS) as low (<10), intermediate (10-20) and high (>20). The primary outcome was time from referral to diagnosis (days). Secondary outcomes were total visits, discharge rate at first consultation, patient cost and adverse cardiac outcomes. RESULTS: The 'Triage Protocol' resulted in shorter times from referral to diagnosis (46 vs 131 days; <0.0001) and fewer total visits (2.4 vs 3.0; <0.0001). However, triage patients in low-risk groups experienced higher costs due to increased testing (S$421 vs S$357, = 0.003). Adverse cardiac event rates under the 'Triage Protocol' indicated no compromise to patient safety (triage vs control: 0.57% vs 0.35%; = 1.000). CONCLUSION By implementing diagnostic cardiac testing prior to patients' first specialist consultation, the 'Triage Protocol' expedited diagnosis and reduced subsequent visits across all risk groups in ambulatory chest pain patients.
Algorithms ; Cardiology Service, Hospital ; Chest Pain ; therapy ; Clinical Protocols ; Female ; Humans ; Male ; Middle Aged ; Primary Health Care ; Treatment Outcome ; Triage ; methods

Brain Injuries, Traumatic ; therapy ; Clinical Protocols ; Enteral Nutrition ; methods ; statistics & numerical data ; Female ; Humans ; Intensive Care Units ; standards ; Male ; Middle Aged ; Nutrition Policy ; Nutrition Therapy ; methods ; standards ; Respiration, Artificial ; Retrospective Studies ; Treatment Outcome

Background: Acne vulgaris is a chronic condition which commonly affects adolescents and exerts a psychological burden on its sufferers. Non-adherence to acne treatment is believed to be a major factor contributing to treatment failure. In this study, we characterize the profile of a non-adherent Asian acne patient, and evaluate the relationship between treatment adherence and acne severity and quality of life. Methods: A total of 53 acne patients were recruited from the Dermatology outpatient clinic of National University Hospital, Singapore, and followed up over a 3 month period in this prospective observational study. The Elaboration d’un outil d’evaluation de l’observance (ECOB) adherence assessment tool was used to assess adherence to acne treatment, and acne severity was evaluated using the US Food and Drug Administration Center 5-point Acne Severity Score (ASS). Results: Of the 53 study participants, 29 (54.7%) were non-adherent to acne treatment. There was no significant difference in gender, educational level or acne severity at time of presentation between adherent and non-adherent patients. Adherent patients had a significantly larger improvement in acne severity scores compared to non-adherent patients (change in ASS: -1.33 ± 0.64 vs -0.76 ± 0.83, p = 0.008), but this did not translate to a significant improvement in quality of life. Conclusion: Adherence to acne treatment was not associated with demographic characteristics or acne severity. Factors contributing to adherence to acne treatment are complex and multi-faceted, and individualized motivation and education of each patient may be the method of choice in encouraging treatment adherence.

Poor adherence to antiepileptic drug (AED) therapy can lead to various undesirable complications. Identifying the contributing factors of poor adherence is beneficial in assisting health care professionals to provide optimal interventions to control the seizures. This study aimed to identify the prevalence and factors affecting the adherence level to AED therapy in a multiracial population with epilepsy. This cross-sectional study was conducted at the neurology clinic of a tertiary care setting. Researcherassisted questionnaire was utilised. Adherence level was assessed using validated Modified Morisky Adherence Scale-8. A total of 145 patients with epilepsy were included in this study. The prevalence of poor adherence to AED therapy was 64.1%. Poor adherence level was significantly associated with younger age (χ2 = 7.609, p = 0.022), medication adverse effects (χ2 = 5.075, p = 0.020), shorter duration of epilepsy (r = 0.180, p = 0.030) and uncertainty about the necessity for AEDs (χ2 = 11.803, p = 0.001). Conclusion, prevalence of poor adherence to antiepileptic drugs was high and factors associated with poor adherence to AEDs were identified for a multiracial population with epilepsy.
Anticonvulsants ; Epilepsy